Introduction to Bowel problems

Going to the toilet to have a bowel movement is something most people take for granted and consider it a very private matter. So when you suddenly experience a problem with your bowels, you can feel rather isolated.

The two most common problems people experience are bowel leakage, when you cannot control when your bowel is open and constipation, where you experience difficulty in moving your bowels.

Learn more about the causes of bowel problems, neurogenic bowel conditions and bowel symptoms.

How common is it to have a bowel problem?

It can be embarrassing to speak out about, which is why many people can go for years without telling anyone about their problem. Because many people never visit their doctor or nurse or reveal their symptoms, the exact number of people affected by bowel problems is unknown. But it is more common than you might think:

• Studies suggest that approximately 2% of the adult population have daily or weekly bowel leakage episodes
  
  
• The prevalence for adults over 65 years is 7%, and in retirement homes it’s as high as 33%
  
  
• Studies indicate that up to 20% of the population have problems with constipation
  
  

Without proper treatment and management, bowel problems can seriously affect quality of life and prevent people from doing the things they enjoy.

Neurogenic bowel can be described as slow movement of stools, constipation, bowel leakage, and difficulty emptying the bowel. Control of the external anal sphincter muscles may also be disrupted, increasing the risk of bowel accidents

There are two main types of neurogenic bowel dysfunction:

• Reflex bowel
  
  
• Flaccid bowel

Reflex bowel

Reflex bowel causes loss of the ability to feel when the bowel is full. Although the anal sphincter muscle (the muscle that keeps the anus closed) remains tight, it will open on a reflex basis when the rectum becomes full and, therefore, the bowel can empty at any time unless appropriately managed. Reflex bowel can occur when the spinal cord is damaged above the T12 level.

Flaccid bowel

Flaccid bowel is when the anal sphincter muscle (that normally keeps the anus closed) becomes relaxed and stays open, often leading to accidental emptying of the bowel. Flaccid bowel is generally caused by damage below the T12 level.

One cause of neurogenic bowel is spinal cord injury (SCI). The impact on bowel function depends on the level of spinal cord injury and where the damage occurs (as mentioned above).

Other possible causes of neurogenic bowel include multiple sclerosis, Spina bifida and Parkinson’s disease.

This is a combination of bowel leakage and constipation. You can be constipated but still experience loose stool that leaks past the hard stool.

It is important to understand that having bowel problems is not a disease in itself. There is usually an underlying cause as to why your bowels aren’t functioning properly. Common causes of bowel problems can be related to either neurogenic or non-neurogenic disorders.

Bowel symptoms can vary depending on the underlying cause. The most common bowel problems people experience are:

Bowel leakage

Bowel leakage is the involuntary passage of stool e.g. you cannot control when your bowel opens, often resulting in bowel accidents.

Constipation

There is no exact science to what constitutes constipation as the symptoms vary from person to person. It is often characterised by decreased bowel movements and straining at defecation.

A lot of people who experience bowel problems may be reluctant to go and talk to their healthcare professional, as bowel problems are very personal and potentially embarrassing subject. It is important to go and seek help, otherwise you may find that your bowel problems start to encroach on daily life.